Antepartum Fetal SurveillanceWillians Ch.15

Antepartum Fetal SurveillanceTo test fetal well-beingFetal physical activitiesMovementBreathingAmniotic fluid productionHeart rateGoal: to prevent fetal death

Fetal MovementsPassive unstimulated fetal activity: 7 wks20~30 wks: rest-activity cycles: 75%20~75

Perception of 10 fetal movements in up to 2 hours is considered normal

Fetal Heart Rate

Non-Stress TestFetal heart rate accelerationsNormal nonstress tests20, 1515

2021515

Worse PrognosisAbsent acceleration up to 80 minsRepetitive decelerations > 3 / 20 minsDeceleration lasting > 1 min

Contraction Stress TestOxytocin challenge test3 spontaneous contractions of 40 sec present in 10 minsNegative: no late or significant variable decelerationsPositive: late decelerations following 50% or more of contractions

Biophysical ProfileBPP

Score 2Score 0Nonstress test2021515 Fetal breathing>1 episode of rhythmic breathing > 30 sec in 30 minsFetal movement> 3 body or limb movement in 30 minsFetal tone>1 () in 30 minsAmniotic fluid volumeSingle vertical pocket > 2 cm

Score10Keep follow up8,normal fluid6~8Deliver if > 37 weeks4Deliver if repeat < 6 0~2Deliver

Fetal Death After Normal BPPFetomaternal hemorrhageUmbilical cord accidentsPlacental abruption

Incidence: 1/1000

Amniotic Fluid Volume

PathophysiologyDecreased uteroplacental perfusionDiminished fetal renal flowDecreased urine productionOligohydramnios

Poor PrognosisSingle vertical pocket < 2 cmAmniotic fluid index ( vertical pocket) < 5 cm

Umbilical Artery Doppler Velocity

Umbilical Artery DopplerS/D ratio: most commonly used indexEnd diastolic flow prognosisPerinatal mortalityAbsent end-diastolic flow: 10%Reversed end-diastolic flow: 33%

SD

40 (A) (B) (C) (D)

Pregnancy 31 weeks with preterm labor, SGA was noted in series OBS sonoKeep tocolysis and observation

Pregnancy 37 weeks with preeclampsia (BP 146/84, urine protein +)MBD with OPD follow up

Pregnancy 24+6 weeks with SLE, hyperthyroidism, hypertension, and preterm laborC/S on 2009/05/08, BW 635gm, Apgar: 2-3

Pregnancy 31+3 weeks with oligohydramnios and preterm labor, with preeclampsia, with HELLP syndrome C/S on 2009/4/08, BW 1140gm, Apgar: 5-8

Antepartum Fetal SurveillanceTelling more about the well-being of the babyAn abnormal result not always mean that the baby is in trouble. It simply mean that you need special care or test